Path 2 Exam 2

TPMA

#1

Atherosclerosis = 80%

10th and 9th

• Most Causes unknown
• Viruses
• - Rubella (german measles) - infection in mother @ 1st Trimester
• Alcohol
• -Fetal Alcohol Syndrome - Etoh effects heart development directly
• Chromosomal Abnormalities
• -Down's Syndrome

• Atrial septal defect
• Ventricular septal defect
• Tetraology of Fallot

• Early cyanosis (skips lungs)
• "blue babies"
• more urgent usually than left to right

• Late cyanosis (reenters lung)
• "blue kids"

• Tetrology of Fallot (most common for early cyanosis)
• Transposition of great vessels (death in 1 month)
• Truncus arteriosus 
• Tricuspid Atresia
• Total Anomalous Pulmonary Venous Return (TAPVR)

Children May squat to increase systemic vascular resistance

• VSD - Ventricular Septal Defect ( MOST COMMON)
• ASD - Atrial Septal Defect (Loud S1; Split S2)
• PDA - Patent Ductus Arteriosus
• VSD > ASD > PDA

This problem leads to progressive pulmonary hypertension and turns into right to left shunt (Eisenmenger's Syndrome)

Any uncorrected VSD, ASD, or PDA.  This leads to inc. pulmonary hypertension --> shunt reverses from L --> R to R --> L, Which causes late cyanosis.  

• Septum of connective tissue that has not been fully closed over AFTER BIRTH
• Occurs in 1 in 2000 births
• Normally while in mother venous blood flows from left atrium to the right via the foramen ovale (this is what does not close)

• The most common congential heart defect recognized in practice
• Left to right shunt (aka L pressure > R Pressure)
• Inc. Backflow through pulmonary aa. --> Pulmonary Hypertension
• Pulmonary Hypertension offsets the inc. pressure from the left ventricle (Shunt Reversal) and dump unoxygenated blood into circulation --> CYANOSIS
• Produces distinct Hear Murmur
• No Sx Needed w/ most patients (Only large Defects)

• 1.)Overriding Aorta (Dextroposition)
• 2.)Pulmonary Stenosis
• 3.)Ventricular Septal Defect
• 4.)Right Ventricular Hypertrophy

• "Blue Babies" - Cyanosis early after birth (R --> L Shunt accross VSD)
• Death Before puberty w/o surgery
• Radiograph shows BOOT SHAPED HEART due to Right Ventrical Hypertrophy

Anterosuperior displacement of the infundibular septum

Compression of femoral aa. inc. pressure. --> dec. the right to left shunt and directing more blood from the RV to the lungs

Aorta leaves RV and Pulmonary trunk leaves LV --> separation of systemic and pulmonary circulations

THIS DOES NOT OCCUR

Failure of the aorticopulmonary septum to spiral, not compatible with life unless shunt is present to allow blood to mix